Presently, highly skilled retinal surgeons complete basic microsurgical objectives by employing high levels of concentration, dexterity and fine motor control, bringing years of training and experience to bear on the defined motor task. Safely and efficiently performing retinal microsurgery requires accurate and precise tool tip control. Accuracy and precision can be facilitated by reducing physiological hand tremor that predominates in a frequency band of about 6-12 Hz, with on the order of 100 μm of motion that is neither directed nor intended. The peeling of micron scale membranes from the delicate retinal surface, without damaging its fragile neurons, is usually accomplished with unassisted freehand tools, such as, for example, a micro-forceps. Attempts to improve the micro-forceps have included, but not limited to, (1) built-in fiberscope and end-effectors to assist in retinal surgery tasks; (2) miniaturization and use of exchangeable micro-forceps as a part of micromanipulation system to assist in minimally invasive surgery; and (3) MEMS technology being applied to the development of micro-forceps for intraocular surgery. See D. C. Riviere, J. Gangloff, and M. Mathelin, “Robotic Compensation of Biological Motion to Enhance Surgical Accuracy,” Proc. of the IEEE 94(9), 1705-1716 (2006); K. Ikuta, T. Kato and S. Nagata, “Development of micro-active forceps for future microsurgery”, Minimally Invasive Ther. Allied Technol. 10(4/5), 209-213 (2001); and T. Kawai, K. Nishizawa, F. Tajima, K. Kan, M. Fujie, K. Takakura, S. Kobayashi, and T. Dohi, “Development of exchangeable microforceps for a micromanipulator system,” Adv. Robotics 15(3), 301-305 (2001), which are herein incorporated by reference in their entirety.
Over the last decade, optical coherence tomography (OCT) has emerged as a dominant diagnostic imaging modality in clinical ophthalmology. See J-P Hubschman, J-L Bourges, W. Choi, A. Mozayan, A. Tsirbas, C-J Kim, and S-D Schwartz, “‘The Microhand’: a new concept of micro-forceps for ocular robotic surgery,” Nat. Eye 24, 364-367 (2010), which is herein incorporated by reference in its entirety. Recently, a force sensing, fiber Bragg grating based micro-forceps to provide force feedback during vitreoretinal surgery has been presented. See X. He, M. A. Balicki, J. U. Kang, P. L. Gehlbach, J. T. Handa, R. H. Taylor, and I. I. Iordachita, “Force sensing micro-forceps with integrated fiber Bragg grating for vitreoretinal surgery,” Proc. SPIE 8218, 82180W-1˜7 (2012), which is herein incorporated by reference in its entirety. Nevertheless, its application as a potential sensor for intraoperative tool control is fairly new.
A microsurgical tool platform Smart Micromanipulation Aided Robotic-surgery Tool (SMART) has been presented for its ability to cancel a surgeon's physiological tremor and to stabilize a handheld imaging probe. See I. Kuru, B. Gonenc, M. Balicki, J. Handa, P. Gehlbach, R. H. Taylor, I. Iordachita, “Force Sensing Micro-forceps for Robot Assisted Retinal Surgery,” in Proceedings of IEEE Conference on Engineering in Medicine and Biology Society (Institute of Electrical and Electronics Engineers, San Diego, 2012), pp. 1401-1404; K. Zhang, W. Wang, J. Han and J. U. Kang, “A Surface Topology and Motion Compensation System for Microsurgery Guidance and Intervention based on Common-Path Optical Coherence Tomography,” IEEE Trans. Biomed. Eng. 56(9), 2318-2321 (2009); J. U. Kang, J. H. Han, X. Liu, K. Zhang, “Common-path optical coherence tomography for biomedical imaging and sensing,” J. Opt. Soc. Korea 14(1), 1-13 (2010); J. U. Kang, J. H. Han, X. Liu, K. Zhang, C. G. Song, and P. Gehlbach, “Endoscopic Functional Fourier Domain Common Path Optical Coherence Tomography for Microsurgery,” IEEE J. of Sel. Top. Quantum Electron. 16(4), 781-792 (2010); Y. Huang, X. Liu, C. Song and J. U. Kang, “Motion-compensated hand-held common-path Fourier-domain optical coherence tomography probe for image-guided intervention,” Biomed. Opt. Express 3(12), 3105-3118 (2012), which are herein incorporated by reference in their entirety. SMART instruments utilize common path, swept source optical coherence tomography (CP SS-OCT) in a closed loop with a piezoelectric motor-based feedback control system. Active tremor reduction of the SMART instruments is achieved by positioning and by continuously and rapidly repositioning the tool tip at a defined constant offset distance from the sample surface by using the piezoelectric motor response to the distance sensing functions of the SS-OCT. The sensor response function of the tool prevents unintended tissue contact and damage, stabilizes tool tip tremor and allows steady positioning of the tool tip at previously unsustainable distances from the target tissue. However, this SMART platform has not been applied to the more complicated functions of micro-forceps.
What is needed are methods, systems and medical devices directed to micro-forceps that can assist in surgical precision and accuracy using OCT.